gms | German Medical Science

Objective: The incidence of inflammatory spinal diseases is steadily increasing during the last decades. Infections of the spine are often life-threatening with persisting and severe neurological deficits caused by destruction of the affected spinal segments, instability, and epidural abscess formation.

Method: Long-term follow-up was performed in 118 patients treated surgically for a pyogenic spinal infection at our institution from 2006.

Clinical evaluation included a detailed anamnesis on admission including pain intensity and location, predisposing factors, type of surgery, and neurological follow-up as well as a detailed lab and radiological work-up. All still living pts were invited to an re-examination including clinical examination, x-ray of the spine, and current complaints with a mean follow-up of 51 months

Results: Comorbidities in our patients were significant. Infections were mainly caused by staph. species and most frequent in the lumbar spine. Intraspinal abscesses were found in 60 pts, extraspinal in 62, and vertebral destruction in 69 pts. On admission 25 pts presented with (in-)complete paraplegia, 47 pts with motor deficits. 180 procedures were performed (27 epidural abscess evacuations only; 116 instrumentations: 22 ventral, 31 dorsal, 63 combined). Early surgical complications included reoperations in 6 cases and wound infections in 10. Other major complications were septic shock in 21 pts, renal failure in 6, and multi-organ failure in 4. Post-op incomplete paraplegia was improved in 6 pts, complete lesions in another 3 cases. Postoperative neurological worsening was noted in 5 pts. 9 pts died in hospital, another 45 later, mainly due to underlying or new diseases. Complete/incomplete paraplegia remained in 4 pts on follow-up. Motor deficits improved 1 grade on average. Nearly half of the surviving patients were able to walk freely for >800 m. All but 1 patient showed radiological signs of bony fusions on follow-up x-rays. 5 pts had to be re-operated on the long-term

Conclusions: Pyogenic spondylodiscitis nowadays mainly occurs in extremely sick and high-risk patients. Diagnosis is often delayed with a high rate of severe neurological deficits before surgery. Surgery in this setting is demanding but will result in a high number of neurological recoveries. Initial mortality and complications are low, but a significant number of patients will die during the first 2 year postoperatively, mainly as a result of their underlying disease.